Gastroschisis repair

Definition

Gastroschisis repair is surgery to correct a birth defect that causes an opening in the skin and muscles covering the belly (abdominal wall). The opening allows intestines and sometimes other organs to bulge outside the belly. The surgeon places the organs back inside the belly and closes the belly wall.

The goal of surgery is to place the organs back into the baby’s belly and repair the defect, if possible. The surgeon will wait until your baby is stable to do surgery. This may take a week to 10 days. During this time, a plastic pouch, called a silo, will be used to return most of your baby’s intestines and other organs into their belly.

When your child is ready for surgery, your baby will receive general anesthesia. This will make your baby unconscious and unable to feel pain during the operation.

The surgeon will examine your baby’s intestine (bowel) closely for signs of damage or other birth defects. Unhealthy parts will be removed, and the healthy edges will be stitched together.

The surgeon will place any abdominal organs that are outside the belly back into the belly.

The opening in the wall of the belly will be repaired, if possible.

More surgery may be needed at a later time to repair the muscles in your baby’s belly.

Why the Procedure Is Performed

Gastroschisis is a life-threatening birth defect. It needs to be treated right after a baby is born.

Risks

Risks for any anesthesia are:

Allergic reactions to medicines

Breathing problems

Risks for any surgery are:

Bleeding

Infection

Blood clots

Additional risks of gastroschisis repair are:

Inflammation of the tissue that lines the wall of the abdomen and covers the abdominal organs

Organ injury

Temporary paralysis (muscles stop moving) of the small bowel

Problems with digestion and absorbing nutrients from food, if a baby has a lot of damage to the small bowel

Breathing problems if the baby's belly area (abdominal space) is smaller than normal. The baby may need a breathing tube and breathing machine for a few days or weeks after surgery.

Before the Procedure

Gastroschisis is usually seen on ultrasound before the baby is born. After it is found, your baby will be followed very closely to make sure they are growing.

Your baby should be born at a hospital that has a neonatal intensive care unit (NICU) and a pediatric surgeon. A NICU is set up to handle emergencies that occur at birth. A pediatric surgeon has special training in surgery for babies and children.

Immediately after birth, any organs outside your baby's body will be covered with warm, moist, sterile bandages or a sterile plastic bag. A nasogastric (NG) tube will be inserted through your baby's nose or mouth into their stomach to drain the stomach to keep it empty. This prevents the baby from choking and breathing stomach contents into the lungs.

After the Procedure

After surgery, your baby will receive care in the hospital's neonatal intensive care unit. They will be placed in a special bed called an isolette. This bed has an incubator to keep your baby warm.

Your baby may need to be on a breathing machine until organ swelling has decreased and the size of their belly area has increased.

Other treatments your baby will probably need after surgery are:

Antibiotics

Fluids and nutrients given through a vein

Oxygen

Pain medicines

An NG tube placed through the nose to drain the stomach and keep it empty.

Feedings are started through the NG tube as soon as your baby’s bowel starts functioning after surgery. Feedings by mouth will start very slowly. Your baby may eat slowly and may need feeding therapy, lots of encouragement, and time to recover after a feeding.

The average stay in the hospital is a few weeks up to 4 months. You may be able to take your baby home once they are taking all foods by mouth and gaining weight.

Outlook (Prognosis)

After you go home, your child may develop a bowel obstruction (a block in the intestines) due to a kink or scar in the intestines.

Most of the time, gastroschisis can be corrected with 1 or 2 surgeries. How well your baby does will depend on how much damage there was to their intestine. After recovery from surgery, most children with gastroschisis do very well and live normal lives.

References

Ledbetter DJ. Gastroschisis and omphalocele. Surgical Clinics of North America. April 2006;86(2).

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